<%@ page contentType="text/html;charset=UTF-8" language="java" %>
<html>
<head>
    <title>新增病例</title>
    <style>
        .a1{
            text-align: center;
        }
        .td1{
            text-align: center;
            background-color: #C3DAF2;

        }
        .td2{
            background-color: #E4EFF7;
            text-align: left;
        }
        .td3{
            background-color: #C7EDCC;
            width: 200px;
        }
        h4{
            width: 100%;
            background-color: #EBEBEB;

        }
        table tr td input{

        }
    </style>
</head>
<body>
<h4><img src="img/main_28.gif"/>&nbsp;病例的录入</h4>
<form>
    <table border="0"style="width: 96%;height: 0px;">
        <tr>
            <td class="td1">就诊卡号</td>
            <td class="td2"><input type="text" name="jzkh" class="td3"/></td>
            <td class="td1">病人姓名</td>
            <td class="td2"><input type="text" name="br_name" class="td3"/></td>
        </tr>
        <tr>
            <td class="td1">病人性别</td>
            <td class="td2"><input type="radio"  class="ipt" name="br_sex" checked="checked"/>男
                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="radio"  class="ipt" name="brxb"/>女</td>
            <td class="td1">病人年龄</td>
            <td class="td2"><input type="text" name="br_age" class="td3"/></td>

        </tr>
        <tr>
            <td class="td1">就诊科室</td>
            <td class="td2"><select name="jzks" style="background-color: #FFFFFF;">
                <option>内科</option>
                <option>外科</option>
                <option selected="selected">儿科</option>
                <option>妇产科</option>
                <option>骨科</option>
                <option>眼科</option>
                <option>口腔科</option>
                <option>五官科</option>
                <option>肿瘤科</option>
                <option>皮肤病科</option>
                <option>中医科</option>
            </select></td>
            <td class="td1">主治医生</td>
            <td class="td2"><input type="text" name="ys_name" class="td3"/></td>
        </tr>
        <tr>
            <td class="td1">联系电话</td>
            <td class="td2"><input type="text" name="ys_name" class="td3"/></td></td>
        </tr>
        <tr>
            <td>&ensp;</td>
        </tr>
        <tr>
            <td></td>
            <td align="right"><input type="button" style="color: #423cfa;" value="提交"></td>
            <td align="left"><input type="button" style="color: #423cfa;" value="返回"></td>
        </tr>
    </table>
</form>
</body>
</html>